by Dawn Eastman
Katie sat with her and offered tissues. She felt like an imposter when Beth thanked her for her kindness.
As she led Beth back to be with her stepfather, her mind drifted. There was one thing that bothered her about Ellen’s death. Katie had no memory of writing that prescription.
2
Katie drove home slowly, trying to make sense of the evening. How could she have missed the signs? And where had Ellen gotten diazepam?
Katie had met Ellen over a year ago while doing a residency rotation with her current partners. She’d learned that Ellen and Christopher were newly married and had relocated from Chicago to Baxter after Christopher’s mother died. There was certainly more to the story if a son only moves home after his parents are dead, but Katie had never pursued it. She understood the need for parental distance.
Ellen had switched her care to Katie three months ago when Katie started working with Emmett and Nick Hawkins. And now the police were suggesting suicide. Katie agreed with Beth. She couldn’t accept it.
But what was the alternative? Ellen had accidentally swallowed an entire bottle of diazepam?
Katie pulled into her driveway and killed the engine. The lights were still on in the dining room. Caleb was awake.
She took a moment to breathe in the comforting smell of wood smoke and autumn leaves. She let herself in the side door and dropped her bag on the kitchen counter. Her brother, Caleb, sat at the paper-strewn dining room table, hunched over his laptop. His hair was long, and he hadn’t shaved in a couple of days. She’d grown used to his pirate look when he was involved in a large software-coding project. He looked up and smiled as she entered the room.
“You’re back earlier than I expected. Is your patient doing better?”
Katie pressed her lips together and shook her head. She wavered between the desire to go straight to bed and the desire to tell Caleb about her evening. Knowing she wouldn’t be able to sleep, talking won. She pulled out a chair and sat.
It was always a struggle to convey her concerns without violating privacy laws. In the past, not ever saying the patient’s name had been good enough. But in a small town like Baxter, the news would be in the public domain before morning.
She focused on the two things that bothered her the most: the idea of the suicide itself and the fact that she didn’t remember writing the prescription that led to Ellen’s death.
When she finished her brief recap, Caleb said, “I’m so sorry, Katie.”
“I don’t know if I can do this, Caleb.” Katie pressed the heels of her hands to her eyebrows. “I can’t believe I didn’t see this coming—again.”
“Katie”—Caleb pushed his laptop away and touched her hand—“none of this is your fault.” He leaned forward and held her gaze. “Just like Mom wasn’t your fault.”
Tears pricked at the back of Katie’s eyes, and she looked away. Why did he always see right through her?
She had only been thirteen. Their mother had been sick for a year, the chemo and surgery draining the life right out of her. But Katie never stopped hoping that a miracle might occur.
She’d known her mother was in horrible pain, but when she started to refuse her pain meds, Katie had thought that maybe things were getting better.
She ran home from school each day hoping her mother would meet her at the door. Every day she let herself in with her key and raced up the stairs to her mother’s bedroom. They couldn’t afford a full-time nurse, but a visiting nurse came every day at lunchtime to check in.
Katie sat with her mom every afternoon and did her homework, chatting about her day and watching for any sign of improvement. But in those last weeks, her mother became silent.
“I’m sorry, Katie-girl,” her mother said. “I don’t think I can hang on any longer. You’re too young to understand, but I can’t take the pain anymore.”
Katie rummaged on her mother’s table and found the bottle of pain medicine. There were only a few tablets left.
“Don’t these work anymore?”
“I think they’ll work just fine, love.”
“Do you want one now?” Katie heard the urgency in her own voice. She wanted her mom back. The healthy mom who used to sing and dance while she cooked dinner. The one who read bedtime stories and did all the voices, even when Katie was too old for bedtime stories.
“No, not yet.” She took the bottle from Katie and set it gently back on the table.
Katie heard nine-year-old Caleb thundering up the stairs. He stayed at a friend’s house every afternoon until their dad brought him home after work. Katie always went to make dinner when Caleb came home.
“Dad brought pizza!” Caleb exclaimed. “Hi, Mom. How are you today? Do you want to have some pizza with us?”
“No, thank you, sweetie. I’m not hungry.”
Caleb’s face fell.
“Why don’t you sit here with me for a minute?”
He pulled up a chair near the bed.
“Tell me about your day.” Her voice was hoarse and quiet. “What did you do at recess?”
Katie slipped out and went downstairs. Her dad had just opened a Coors—the first of what would likely be many for the night. She’d never seen her dad drink more than one beer—except on Sunday while watching football—until her mom got sick. Now he sat and drank like his life depended on it. Katie was grateful that he usually just fell asleep; she knew from her friends that sometimes people got loud, or mean, or silly when they drank. Katie’s dad just checked out.
“How’s your mom?” he asked.
“The same. She says she’s not hungry. I know she’s in pain, but she doesn’t want any medicine right now. I think she needs more.”
Her dad held up a medicine bottle. “I picked up a refill on my way home. I’ll bring it up to her in a minute and talk her into taking some.” He drained the beer bottle. Katie had noticed that he never went to see her mom without at least one beer in his stomach.
Caleb came into the kitchen. He glanced at the beer bottle on the counter, looked at Katie, and hung his head. “I’m gonna watch SpongeBob and eat my pizza.”
“I’ll watch with you,” Katie said.
She heard her dad’s heavy, slow tread on the stairs.
She wished, later, that she remembered more about that night. What she had watched, what she and Caleb had laughed at, and what time her dad had passed out. But it all became a blur the next morning when she went to say good-bye to her mom on the way to school.
She knew the minute she walked into the room. It was too still, as if all her mother’s items were holding their breath, waiting for someone to discover their dead owner. The smell in the room was stronger this morning. Katie had gotten used to the faint odor of decay and medicine that lingered around her mother. She walked slowly to the bed. Her mom’s face was gray. She lay still and quiet, not breathing.
Katie glanced at her mother’s bedside table and saw three empty bottles of medicine. They hadn’t been there the last time Katie was in the room. She grabbed all three and read the labels. And then she started to cry.
“Katie?” Caleb moved his hand in front of her face, breaking the spell of memory.
She would never come right out and say it, but she was grateful for Caleb. They had stuck together as their father fell deeper into his grief and alcohol. Shuttled from one relative to another while in school, they ended up living all over Michigan. And they had only been separated for the four years that Katie was in college. He knew her better than anyone. He knew about the guilt that she could never quite shake.
In medical school interviews, they always asked, “Why do you want to be a doctor?” Katie’s answer was that her mother died of cancer, which would elicit a sympathetic face and rapid progression to the next question. But that wasn’t really the whole story. Her mother didn’t actually die of cancer, and Katie had so far spent her adult life in a daily do-over. She never wanted to miss a cry for help or a subtle sign of illness again. And now she had.
She gave him
a small, reassuring smile. “I know. Sometimes people don’t want to be helped.”
Caleb relaxed into his chair. He’d heard what he was hoping to hear.
Katie said good-night and went to her room. After a quick trip to the bathroom to brush her teeth, she climbed into bed. She knew that she wouldn’t be able to sleep right away. She picked up the photo of her mother that she kept by her bed. It had been taken a year or so before the diagnosis, and her mom still had her beautiful strawberry-blonde curls and perfect skin. Katie shared her mom’s deep-blue eyes and upturned nose. Katie’s hair was just as curly, but darker. She missed her every day. And felt guilty every day.
Caleb might know her better than anyone, but he didn’t know everything.
3
“Did you hear about Ellen Riley? It’s alarming!” exclaimed Mrs. Winchester.
“I did hear about it, Mrs. Winchester,” Katie said. “But what is equally alarming is your blood pressure.”
Mrs. Winchester was normally one of her favorite patients, but Katie’s lack of sleep had made her cranky. Katie turned to wash her hands in the sink and wondered yet again how she’d gotten through her residency. It had been routine in the beginning to get only moments of sleep in a thirty-six-hour period, but now that she was on a more normal schedule, it was as if her brain refused to go back to functioning on so little sleep ever again. Even her hair was tired. It hadn’t put up any fight when she twisted it into a clip that morning and not one curl had sprung loose. Mrs. Winchester was only the fourth patient of the morning, and Katie was already running almost an hour late.
At eighty-four years old, Mrs. Winchester took care of Mr. Winchester, her dying sister-in-law Gladys, and a gang of cats. Her blood pressure was frequently out of control, particularly on housecleaning days. Fighting the dust and dirt that accumulated over one week’s time—an alarming amount—got her worked up.
Each of Katie’s patients had heard a version of Ellen Riley’s death. Those that had been out of the loop due to the lack of a phone or the appropriate gossip contacts got all the information they needed by sitting in Katie’s waiting room. Katie tried to steer Mrs. Winchester back to the matter of her blood pressure, but she was already plowing ahead.
“Such a nice woman—although probably too city for Baxter,” she mused. “She may have done better in Ann Arbor. There’s more traffic there, you know.” She looked at Katie over the rim of her glasses as if the traffic were her fault. “How you young people can drive with all those other cars on the road is beyond me. Why, when we had to go to the University Hospital in Ann Arbor for those tests, I thought we’d never make it back. Even driving here today, we must have passed fifteen cars! Right here in Baxter! What is the world coming to?” She tilted her head so Katie could look in her ears. “And driving so fast, it’s alarming! But poor Mrs. Riley, I just can’t believe it. Why anyone married to Christopher Riley would want to die I just can’t understand. Such a handsome man, like my Henry when he was young . . .” She stopped talking while Katie listened to her heart. “What’s the verdict, dear?”
“You’re just as healthy as last time, but your blood pressure is still too high,” Katie said. “I’m going to change your dosage and see you back in three months.”
“All right, dear.” Mrs. Winchester cocked her head. “You look tired today. I hope you aren’t working too hard. And you’re too thin. I’ll drop off a casserole.”
Katie smiled at her and held out a hand to help her off the exam table. “I’m fine, Mrs. Winchester. I don’t think I work nearly as hard as you do. Say hello to Gladys and Mr. Winchester for me. I’ll see you in a few months, okay?”
Katie quickly stepped into the hall before Mrs. Winchester could continue her diatribe against all things modern. Or question Katie’s health and lifestyle choices.
She closed the door, turned, and saw Nick Hawkins standing behind the nurse’s desk watching her. He was tall with slicked-back blond hair and a penetrating stare.
“I’ve been looking for you,” he said. “Every time I’m out of a room, you’re in one.” He came around the desk and lowered his voice. “I’m really sorry about the call last night. I don’t know what happened. I must have been in a dead zone.” He winced, realizing his poor choice of words. Katie knew that he and Christopher Riley had been friends for years. It was probably just as well that she had been the one to take the call.
“It’s fine. Ellen was my patient anyway.” Katie took a step back. “I’m sorry; I know you were friends.”
Nick nodded. He ran a hand over his face and Katie noticed the purple smudges beneath his eyes. She wondered if he’d been up all night too.
“Thanks,” he said. “Christopher is devastated.” He looked like he was about to say more, but his nurse peeked around the corner and held up three fingers. Nick ran a pain clinic three days a week as well as a regular family medicine clinic. He specialized in palliative care and treating chronic pain. It seemed to Katie that he managed to see twice as many patients as she did.
“I’m falling behind,” he said. “Better get back to work.” And he disappeared around the corner.
Katie walked down the hall to her office and shut the door. She gulped down her third cup of coffee and pulled her schedule up on the computer. What a day this was going to be. Her already full calendar had been crammed with add-ons. Scanning the list of ailments, Katie suspected word had gotten out that she had information on Ellen. Debra Gallagher, the receptionist, was less than discreet and was probably passing out information in the waiting room. With any luck, some of her appointments would get the gossip they needed and have miraculous recoveries.
Thinking about her clinic as compared to Nick’s, Katie got an idea. He turned over almost all the paperwork to his nurse. They had preprinted prescription pads, and all he did was sign them. Katie wrote most of her own prescriptions, but she realized that she didn’t know if prescriptions were logged somewhere when the nurses called them in to the pharmacies. They must be. A doctor would need to sign off on them.
She took the back hall to Angie’s office. Angie Moon was the head nurse and office manager. Katie peeked around the door and saw that Angie was scribbling notes on a yellow legal pad. Her straight dark hair fell forward as she worked. She startled when Katie knocked on the doorframe.
“Oh, Dr. LeClair, you surprised me,” she said. She slid the pad under a pile of charts on the corner of her desk.
“Sorry, Angie.” Katie leaned into the office. “I was hoping you could help me understand some of the charting.”
Angie nodded and gestured toward a chair in front of her desk.
Katie entered and sat, suddenly feeling unsure. She didn’t want to focus attention on the prescription until she knew more. However, she needed to know how Ellen had gotten the medication that had killed her. Curiosity won over discretion. She clasped her hands tightly in her lap and jumped in. “If I make a note to call in a prescription to the pharmacy, is there a separate place where that gets recorded, or does it go directly into the patient’s chart?”
“Did something not get called in?” Angie pulled out a different note pad and prepared to take notes on this breach of protocol.
“No, everything is fine. I just wondered . . .” Katie hadn’t thought this through. But then she had an idea. “If I call in a refill while I’m on call, do I just make a note in the chart, or do I have to enter it somewhere else?”
“Oh, I see.” Angie put her pen down. “You can write it in the chart, but if you don’t want to bother, you can fill out a call sheet, and Pauline will file it in the chart—eventually. However, if you prescribe something new, it would be better if you put it in the chart itself so that you’re sure it gets recorded properly—especially if it’s Dr. Emmett’s or Dr. Nick’s patient so they know what you’ve changed.”
Katie nodded. “And if I ask my nurse to call in a prescription, where does it get recorded?”
“Usually, she’ll make a note in the chart. But no matter
what, we log it into the med book so we have a record of what was called in and when.”
“So if a prescription is called in, there is always a note in the med book?”
Angie nodded. “We’re especially careful about Dr. Nick’s pain patients. Any patient on narcotics is closely monitored.”
“And you have the book here in your office?”
“No. It’s in the med room.” Angie narrowed her eyes. “Are you sure there isn’t a problem?”
“No, no problem. Thanks, Angie.” Katie stood and went to the door. “I just wanted to be sure I’d checked all the boxes.”
“I have no worries about you, Dr. LeClair,” Angie said, “and I’m really sorry about Ellen Riley. I heard you were there in the ER.”
“I was, but it was too late to do anything for her.”
Angie shook her head. “Sometimes this job sucks.”
Katie gave a brief nod and returned to her office—she had a plan, but it would have to wait until after she’d seen her patients.
At six o’clock, Katie was finally done with clinic. A few no-shows and cancellations in the afternoon had lightened the load and confirmed her suspicions.
Katie sat at her desk with a stale half sandwich from lunch and a pile of charts. The electronic medical record system hadn’t found its way into this small practice just yet, and the doctors still handwrote their clinic notes. Katie was pretty sure the oldest partner, Emmett, hoped to hold out until retirement. He wasn’t a fan of computers, and Katie had learned not to bring it up for fear of inviting another rant against the digital age.
An hour passed quickly as she scribbled notes while reliving each patient encounter. In residency, she’d done this with a click of a mouse. The computer saved time, but she found the writing reassuring. She revisited the complicated patients and made sure she’d thought of all the options. Sometimes she found things she’d missed.
